Reviews and complaints application form

You can use this form to ask us to review an agency’s decision under the Government Information (Public Access) Act 2009 (GIPA Act) or to make a complaint about the way an agency has acted (or failed to act) when exercising its functions under the GIPA Act.

If you prefer, a word version of this form is available for you to print and send to us. Form: GIPA reviews and complaints (Word version, 464kb)

This is an application for: (please choose one) 'required'
Section 1: details
Note: a copy of this form and any related information you send us may be sent to the agency
Do you require special assistance when communicating with us? if so, please select:
Does this person know you have submitted this application on their behalf?
Please tick which of the following describes your application: 'required'
(You may tick more than one option)
(See footnote for explanation of “conduct”)
(Please be as specific as you can)
We must receive this application within 40 working days of the date the agency made a formal decision or we may not be able to help you. If we cannot help you, we will let you know what your other options are. You can post or email this form to us or call us to make an application over the phone.
Note: If you have sought a review with NCAT, the IPC cannot review the same decision. You must seek an internal review before coming to us unless you are the person who asked for the information.
(For example: Release a particular item of information, provide an apology, change policies or practices, provide training for staff, etc.)
Section 2: Verification
Section 3: Other information